1. Field of the Invention
The present invention relates generally to medical care management systems. More particularly, the present invention relates to a directed medical care expert system and method for educating and guiding an individual through a process of making difficult and complicated end-of-life decisions and creating a comprehensive and accessible medium, such as a document, for easily directing medical personnel to provide a particular level of medical care chosen by the individual and which provides medical personnel with answers to vital medical-related questions for providing care and/or treatment during an individual's medical emergency. The subject invention relates also to a medical care management system and method that controls access, storage, revision, maintenance and immediate distribution of medical care instructions created by the expert medical care system.
2. Description of the Prior Art
The current system of living wills, do not resuscitate orders (DNR's) and advance directives is fragmented, non-uniform out-dated and fails to provide appropriate medical information to medical personnel for assisting in providing medical treatment to an individual. The current system also lacks a mechanism for educating an individual for making the most appropriate decisions for the particular individual's medical situation or which are best in line with the individual's specific desires. Furthermore, the current system lacks the ability to change, amend or otherwise update the individual's decisions for medical care treatment and for providing medical personnel immediate access to those changes. Still further, the present system lacks transportability of medical care decisions so that the medical care directives are either able to be easily transported on an individual's person or is easily and immediately obtained by medical personnel. An issue which must be addressed is that many individuals arrive at a hospital without advance medical directives.
Patients checking into hospitals and clients meeting with their lawyers often are advised to take a simple step toward planning for the future by preparing a living will. The intent is good; however, the reality of living wills is they do not sufficiently work. A living will might direct that no extraordinary measures be used if a person's condition is terminal. Since the terms “extraordinary measure” and “terminal” are often not defined, confusion may arise. In turn, medical personnel often times avoid referring to the medical directives set forth in a living will in order to avoid confusion. Yet another issue which arises is that many living wills are vague and lack the appropriate medical information, thereby essentially rendering them useless in many instances.
Standard DNR orders attempted to simplify the process by presenting an individual with only three different choices. In theory, this system is beneficial since it is relatively simple. However, such simplicity has shown to be disadvantageous since there are too many presenting scenarios and categorizing these scenarios into one of three choices is unrealistic. Because of this, DNR documents are also often times ignored by medical personnel.
In addition, standard DNR orders or other medical directive documents, lack transportability and immediate availability to medical personnel. As noted above, this renders such documents useless since they are often times not available at the time of need, which in turn means that the individual's emergency and/or end-of-life desires are not met and the individual's wishes for resuscitation are not available.
The concept seems to be straightforward: an individual should outline his or her wishes while he or she is healthy in order to guide doctors and family members who might have to make life or death decisions for the individual at a later time. A typical question that an advance medical directive should answer is whether a person would want to linger in a vegetative state if it were unlikely he or she would ever recover, or would that person prefer to be allowed to die? Clearly, end-of-life medical questions often involve complicated medical decisions.
Another typical question involves the situation where a person is suffering from an end-stage disease and whether that person would want treatment if the treatment would only provide a minimal chance of extending the person's life or would only extend the person's life for a short period of time, i.e., a few days to a few weeks For example, should an end-stage Alzheimer's patient who has signed a DNR comfort care order (which typically do not include a provision for antibiotics), whose life is greatly diminished but still has moments of joy and conversation, be given the option for use of antibiotics to treat an infection that if left untreated might cause the person's death?
There are other problems as well. For example, people often change their minds after they write their advance medical directives, but neglect to update the advance directives to reflect these changed desires. Furthermore, many advance directives (or living wills) never arrive to the patient's bedside, but rather are left in a file cabinet or safety deposit box or are even lost or misplaced. Moreover, even if the living will is available, family and doctors often have difficulty in deciphering the patient's wishes due to the inherent ambiguity and lack of appropriate medical information set forth in the documents. As noted above, most times these documents do not accompany the patient to the hospital, and therefore are not readily accessible, thereby rendering the documents moot.
An additional issue that arises relates to the fact that most individuals are not familiar with most medical and/or legal terms and procedures which deal with end-of-life decisions. For example, an individual might assume based on preconceived notions that being placed on a respirator should be avoided regardless of the medical emergency situation. In reality, the individual might not understand that in certain situations a respirator might simply facilitate recovery from an illness which might otherwise cause the person's death. However, not having access to this information may result in the patient making an uneducated or poorly informed medical decision, in which case the individual may reject a particular treatment, such as placement on a respirator. In this case, the individual would reject treatment which could potentially facilitate recovery, and consequently, the person suffers a premature death. Having access to the information for making a fully informed and educated decision might cause the individual to reconsider the decision to not be placed on a respirator regardless of the medical emergency situation. Therefore, there is a need for providing an individual with the information and education necessary to fully understand the decisions which are set forth in the medical directives in an easily understood and accessible manner.
Another issue which must be addressed is the overwhelming concern about litigation. Since 1990, most states require hospitals to offer all patients a chance to prepare a living will. Despite the law and despite several high-profile end-of-life legal disputes, most people still do not have some form of advance medical directive. Thus, there is a need for a system and method for guiding and educating an individual through the process of end-of-life decisions and creating a comprehensive medium, such as a document to easily direct a medical care provider to grant a level of care chosen by the individual. There is also a need for a medical care management system and method that control access, storage and revisions, along with immediate distribution of the medical care instructions created by the medical care system. The subject invention overcomes the above-noted limitations and provides a system and method for guiding and educating an individual through the process of making end-of-life medical decisions and creating a comprehensive document to easily direct the medical care provider to grant the level of care chosen by the individual. The subject invention also presents a management system and method that control access, storage, revision, maintenance, immediate distribution and timing of medical care instructions created by the medical care system, and that guide the medical care provider to grant the particular level of care chosen by the individual.
Yet another issue which must be addressed pertains to post-death organ donation. Many individuals may not have considered the option of organ donation once the individual has passed away. Moreover, many individuals may not sufficiently understand the process of organ donation or they may believe that organ donation only means that the organs are donated to other individuals in need of new organs. However, there is a tremendous need for relatively healthy organs to be donated to assist other individuals who are still living. In addition, there is a need for organs to be donated for scientific research purposes. Therefore, there is a need for providing an individual with the information necessary to fully understand organ donation and all possible options for donating organs for post-death use, as well as for assisting the individual in making organ donation decisions and making those decisions readily accessibly to medical personnel. The current system for organ donation is fragmented and lacks an appropriate mechanism for educating individuals or documenting the individual's decisions.
An example of a prior art living will storage is set forth in U.S. Pat. No. 5,241,466 (Perry, et al.). Perry, et al. discloses a central depository for storage and retrieval of important documents and information, such as living wills, and other related documents. The depository includes a data storage facility having a computer and WORM drive CD-ROM player connected to an optical scanner. The relevant documents are scanned by the optical scanner and stored on the CD-ROM player. Requests for information can be received by the depository from remote locations by data transmission devices. The system also provides a procedure for updating the information and documents as legislation regarding the stored information and documents changes, as well monitors for changes in residence which may affect the information and documents. A disadvantage with the Perry, et al. prior art system is that it fails to provide a procedure or mechanism for educating or otherwise providing information to an individual to facilitate the process of making fully informed end of life decisions.